Skip to main content

Advertisement

SpringerLink
Log in

Visual field defects due to optic disk drusen in children

  • Pediatrics
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

Optic nerve head drusen (ONHD) are deposits due to abnormalities in axonal metabolism and degeneration. Studies so far have focused on adults. Our aim was to study the effect of ONHD on visual function as well as optic nerve head structure using optical coherence tomography (OCT) in children.

Methods

Subjects younger than 18 years of age with ONHD and who had a reliable visual field defect in at least one eye due to ONHD were considered for inclusion. All subjects underwent an extensive ophthalmic examination including best-corrected visual acuity (BCVA), funduscopy, and SITA 24–2 standard automated perimetry. OCT scanning was performed using Cirrus-HD Model 4000. Retinal nerve fiber layer (RNFL) thickness data were compared with a group of age-matched healthy children.

Results

Fifteen children were included, with a mean age of 13 years (range 7 to 17 years). BCVA was 1.0 in all eyes, except in a child with concomitant esotropia. ONHD were bilateral in 13 children. Among the 28 eyes with ONHD, 12 (43 %) were classified as type 1 (buried), eight (29 %) as type 2 (ringed) and eight (29 %) as type 3 (superficial). All children had a visual field defect in at least one eye, according to the inclusion criteria; however, two eyes (7 %) had no defect in spite of the presence of ONHD. Five eyes showed an isolated enlarged blind spot (18 %), 15 cases showed a nasal defect (54 %), and six eyes showed a constricted visual field (21 %). RNFL thickness was higher in type 1 and 2 ONHD than in the control group, although these differences were only significant for the average, superior, and inferior quadrant thicknesses in type 1 and the inferior quadrant in type 2. RNFL thickness was lower in type 3 ONHD than in the control group, although these differences were only significant for the average, superior, and nasal quadrant thicknesses.

Conclusions

ONHD may lead to the development of visual field defects, even in children. In initial stages, ONHD produce an increase in RNFL thickness as measured with OCT. As drusen develop and become superficial, the RNFL thickness decreases. The temporal quadrant is often undamaged, probably reflecting the preservation of central visual acuity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hoover DL, Robb RM, Petersen RA (1988) Optic disc drusen in children. J Pediatr Ophthalmol Strabismus 25(4):191–195

    PubMed  CAS  Google Scholar 

  2. Erkkila H (1975) Clinical appearance of optic disc drusen in childhood. Albrecht Von Graefes Arch Klin Exp Ophthalmol 193(1):1–18

    PubMed  CAS  Google Scholar 

  3. Kamoun RI, Boussen M, Beltaief O, Ouertani A (2008) Drusen in children: three case studies. J Fr Ophtalmol 31:e1

    Article  PubMed  CAS  Google Scholar 

  4. Erkkila H, Raitta C, Niemi KM (1983) Ocular findings in four siblings with pseudoxanthoma elasticum. Acta Ophthalmol 61(4):589–599

    Article  CAS  Google Scholar 

  5. Gili Manzanaro P, Yanguela Rodilla J, Rodriguez Caravaca G, Carrasco Font C, Martin Rodrigo JC, Arias Puente A (2010) Decreased visual acuity from optic disc drusen. Arch Soc Esp Oftalmol 85:64–69

    Article  PubMed  CAS  Google Scholar 

  6. El-Koofy NM, El-Mahdy R, Fahmy ME, El-Hennawy A, Farag MY, El-Karaksy HM (2011) Alagille syndrome: clinical and ocular pathognomonic features. Eur J Ophthalmol 21:199–206

    Article  PubMed  Google Scholar 

  7. Sturm V, Leiba H, Menke MN, Valente EM, Poretti A, Landau K, Boltshauser E (2010) Ophthalmological findings in Joubert syndrome. Eye (Lond) 24:222–225

    Article  CAS  Google Scholar 

  8. Gregory-Evans K, Rai P, Patterson J (2009). Successful treatment of subretinal neovascularization with intravitreal ranibizumab in a child with optic nerve head drusen. J Pediatr Ophthalmol Strabismus:1–4

  9. Knape RM, Gandhi KB, Tuli SY, Khuddus N (2010). Optic nerve findings in CHILD syndrome. J Pediatr Ophthalmol Strabismus; 47 Online: e1–e3

  10. Nanji AA, Klein KS, Pelak VS, Repka MX (2012) Nonarteritic anterior ischemic optic neuropathy in a child with optic disk drusen. J AAPOS 16:207–209

    Article  PubMed  Google Scholar 

  11. Barrio-Barrio J, Noval S, Galdós M, Ruiz-Canela M, Bonet E, Capote M, López M (2013) Multicenter Spanish study of spectral domain optical coherence tomography in normal children. Acta Ophthalmol 91:e56–e63. doi:10.1111/j.1755-3768.2012.02562.x

    Article  PubMed  Google Scholar 

  12. Frisen L (2008) Evolution of drusen of the optic nerve head over 23 years. Acta Ophthalmol 86:111–112

    Article  PubMed  Google Scholar 

  13. Wilkins JM, Pomeranz HD (2004) Visual manifestations of visible and buried optic disc drusen. J Neuroophthalmol 24:125–129

    Article  PubMed  Google Scholar 

  14. Obuchowska I, Mariak Z (2008) Visual field defects in the optic disc drusen. Klin Oczna 110(10–12):357–360

    PubMed  Google Scholar 

  15. Patel NN, Shulman JP, Chin KJ, Finger PT (2010) Optical coherence tomography/scanning laser ophthalmoscopy imaging of optic nerve head drusen. Ophthalmic Surg Lasers Imaging 41(6):614–621

    Article  PubMed  Google Scholar 

  16. Thurtell MJ, Biousse V, Bruce BB, Newman NJ (2012) Optic nerve head drusen in black patients. J Neuroophthalmol 32(1):13–16

    Article  PubMed  Google Scholar 

  17. Savino PJ, Glaser JS, Rosenberg MA (1979) A clinical analysis of pseudopapilledema. II. Visual field defects. Arch Ophthalmol 97(1):71–75

    Article  PubMed  CAS  Google Scholar 

  18. Katz BJ, Pomeranz HD (2006) Visual field defects and retinal nerve fiber layer defects in eyes with buried optic nerve drusen. Am J Ophthalmol 141:248–253

    Article  PubMed  Google Scholar 

  19. Lee AG, Zimmerman MB (2005) The rate of visual field loss in optic nerve head drusen. Am J Ophthalmol 139:1062–1066

    Article  PubMed  Google Scholar 

  20. Calvo-Gonzalez C, Santos-Bueso E, Diaz-Valle D, Reche-Frutos J, Moriche-Carretero M, Benitez-Del-Castillo JM, Garcia-Sanchez J (2006) Optic nerve drusen and deep visual fields defects. Arch Soc Esp Oftalmol 81(5):269–273

    PubMed  CAS  Google Scholar 

  21. Mustonen E (1983) Pseudopapilloedema with and without verified optic disc drusen. A clinical analysis II: visual fields. Acta Ophthalmol 61(6):1057–1066

    Article  CAS  Google Scholar 

  22. Johnson LN, Diehl ML, Hamm CW, Sommerville DN, Petroski GF (2009) Differentiating optic disc edema from optic nerve head drusen on optical coherence tomography. Arch Ophthalmol 127:45–49

    Article  PubMed  Google Scholar 

  23. Wester ST, Fantes FE, Lam BL, Anderson DR, McSoley JJ, Knighton RW (2010) Characteristics of optic nerve head drusen on optical coherence tomography images. Ophthalmic Surg Lasers Imaging 41(1):83–90

    Article  PubMed  Google Scholar 

  24. Slotnick S, Sherman J (2012) Buried disc drusen have hypo-reflective appearance on SD-OCT. Optom Vis Sci 89(5):E704–E708

    Article  PubMed  Google Scholar 

  25. Lee KM, Woo SJ, Hwang JM (2011) Differentiation of optic nerve head drusen and optic disc edema with spectral-domain optical coherence tomography. Ophthalmology 118:971–977

    Article  PubMed  Google Scholar 

  26. Sarac O, Tasci YY, Gurdal C, Can I (2012) Differentiation of optic disc edema from optic nerve head drusen with spectral-domain optical coherence tomography. J Neuroophthalmol 32(3):207–211

    Article  PubMed  Google Scholar 

  27. Roh S, Noecker RJ, Schuman JS, Hedges TR 3rd, Weiter MC (1998) Effect of optic nerve head drusen on nerve fiber layer thickness. Ophthalmology 105:878–885

    Article  PubMed  CAS  Google Scholar 

  28. Pollack IP, Becker B (1962) Hyaline bodies (drusen) of the optic nerve. Am J Ophthalmol 54:651–654

    PubMed  CAS  Google Scholar 

  29. Morris RW, Ellerbrock JM, Hamp AM, Joy JT, Roels P, Davis CN Jr (2009) Advanced visual field loss secondary to optic nerve head drusen: case report and literature review. Optometry 80:83–100

    Article  PubMed  Google Scholar 

  30. Nentwich MM, Remy M, Haritoglou C, Kampik A (2011) Radial optic neurotomy to treat patients with visual field defects associated with optic nerve drusen. Retina 31:612–615

    Article  PubMed  Google Scholar 

  31. Pfriem M, Hoerauf H (2011) Unsuccessful surgical excision of optic nerve drusen. Graefes Arch Clin Exp Ophthalmol 249(10):1583–1585

    Article  PubMed  Google Scholar 

  32. Knape RM, Zavaleta EM, Clark CL 3rd, Khuddus N, Peden MC (2011) Intravitreal bevacizumab treatment of bilateral peripapillary choroidal neovascularization from optic nerve head drusen. J AAPOS 15:87–90

    Article  PubMed  Google Scholar 

  33. Silva R, Torrent T, Loureiro R, Travassos A, de Abreu JR (2004) Bilateral CNV associated with optic nerve drusen treated with photodynamic therapy with verteporfin. Eur J Ophthalmol 14(5):434–437

    PubMed  CAS  Google Scholar 

  34. Sullu Y, Yildiz L, Erkan D (2003) Submacular surgery for choroidal neovascularization secondary to optic nerve drusen. Am J Ophthalmol 136:367–370

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pediatric Ophthalmology Department, La Paz University Hospital, Paseo de la Castellana 261, 28046, Madrid, Spain

    Susana Noval

  2. Pediatric Ophthalmology Department, Parc Taulí University Hospital, Sabadell. Instituto Microcirugía Ocular, Barcelona, Spain

    Josep Visa

  3. Opthalmology Department, Ramón y Cajal University Hospital. Clínica Rementería, Madrid, Spain

    Inés Contreras

Authors
  1. Susana Noval
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Josep Visa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Inés Contreras
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Susana Noval.

Additional information

No authors have any financial/conflicting interests in relation with any of the items or pathologies mentioned in this report. We have full control of all primary data, and we agree to allow Graefes’ Archive for Clinical and Experimental Ophthalmology to review them upon request.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Noval, S., Visa, J. & Contreras, I. Visual field defects due to optic disk drusen in children. Graefes Arch Clin Exp Ophthalmol 251, 2445–2450 (2013). https://doi.org/10.1007/s00417-013-2384-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-013-2384-6

Keywords

Search

Navigation